Diabetes – An unsolicited guest during pregnancy

Out of the various medical conditions that rule during pregnancy, the medical complications arising due to diabetes holds its own significance. Diabetes during pregnancy is termed as gestational diabetes.

Like in type 1 diabetes (where the pancreas produces little or no insulin) and in type 2 diabetes (where body does not utilize insulin properly), gestational diabetes is caused when your body naturally becomes more resistant to insulin during pregnancy. This happens so that more glucose is available to nourish your baby. The pancreas is unable to keep up with the increased demand for insulin during pregnancy resulting to high blood sugar levels.
Unlike other types of diabetes, gestational diabetes isn’t permanent. Once a baby is born, blood sugar mostly returns to normal after delivery. But, it needs to be recognized and treated quickly because it can cause health problems for both the mother and the baby.

Dr Neeta Gupta (MD, MRCOG, Fellow Reproductive Medicine and currently working as as an infertility consultant at Fortis Noida) expands further:

-Whether a woman is trying to conceive or already pregnant, treating diabetes during pregnancy is key to the health of both the expecting mother and the baby. Gestational Diabetes usually starts between week 24 and week 28 of pregnancy when the body does not produce enough insulin (the hormone that helps convert sugar into energy) to deal with the increased glucose, or sugar, that’s circulating in your blood to help your baby grow.?

The nature of risks diabetes can cause to both are worth noting:

Risks for the baby
-Premature delivery (baby may be born too early), heavy weight, or have breathing problems or low blood glucose right after birth.
-Miscarriage or sudden IUD (baby dies in the womb during the second half of pregnancy)
-Birth defects: A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful as it may increase the chance of having birth defects, such as heart defects or defects of the brain or spine.
-Big baby (a condition called Macrosomia) occurs due to excess insulin crossing the placenta. It causes obstructive labor and can make vaginal delivery difficult increasing the risk of terminal injuries to the baby during the birth process. Being born large can also lead to high blood sugar levels in baby at birth and obesity later in childhood.
-Jaundice can also be attributed to diabetes while pregnant

Risks for the mother
-Preeclampsia (high blood pressure usually with protein in the urine called toxemia). Preeclampsia can cause serious or life-threatening problems.
– Worsening of diabetic eye and kidney problems
-Infections of the urinary bladder and vaginal area
-Difficult delivery or cesarean section

Now, the question is how to avert diabetes during pregnancy?

Dr Neeta Gupta explains that there are two situations i.e. a woman has diabetes before conception or she acquires diabetes during pregnancy, the solution is primarily the same for both.

“If your risk factors for gestational diabetes are a family history of the disease and/or advanced maternal age, there may be nothing more you can do to prevent your chances of developing the condition. But, for all other reasons, staying active, eating a healthy diet and keeping an eye on the scale can have a big impact on reducing your risk of developing both gestational diabetes and type 2 diabetes before you conceive or during your pregnancy.”

Another most important aspect to ward off your situation of diabetes is to involve your health care team in managing your diabetes. It is strongly recommend to include the following in your healthcare team:

– A medical doctor who specializes in diabetes care, such as an endocrinologist or a diabetologist
– An obstetrician with experience treating women with diabetes
– A registered dietitian to help with meal planning

You may require frequent visits to them to ensure proper management of blood glucose levels and monitoring you and your baby’s health.

In addition, you may require specialists who diagnose and treat diabetes-related problems, if you experience problems such as vision problems, kidney disease and heart disease.

The good news is that while the potential complications from untreated gestational diabetes are serious, the condition can be easily managed with the help of your healthcare team, but, what is equally important is an early diagnosis to the problem.

Blood sugar testing before conception and between 24th and 28th week of pregnancy should be undertaken. A pre-pregnancy exam by your doctor typically includes measuring your HBA1C level (average blood sugar levels over a period of weeks/months) to make sure blood glucose levels are under control. A glucose screening test, where you are required to drink a sugary liquid and have your blood drawn an hour later may depict your situation well. If your levels are high, your doctor will have you take a three-hour glucose tolerance test to determine whether you have gestational diabetes or not.

What to do when diagnosed with gestational diabetes?

a. Monitor your blood sugar level several times a day. Check first thing in the morning to get your fasting rate and then an hour after you eat each meal to make sure your blood sugar stays in a healthy range.
b. Get a diet plan from your dietician. Many women may have to stick to their gestational diabetes diet of low-carbohydrates, low-sugar foods even after delivery for some time. Keeping food log is also a good idea to understand what foods are spiking your blood sugar.
C. Exercise and stay active.
d. You may be required to undergo additional fetal monitoring in your third trimester to ensure baby’s heart rate and movements are normal.
e. You may be asked to take diabetes medicines to help you manage your diabetes.
f. Most likely you will be advised vitamins and folic acid 3 months prior to conception and even after conceiving to help you and your baby stay healthy.

“Many women are able to sail through their diabetes in pregnancy with promising results. The only mantra is to manage your glucose levels, prioritize proper nutrition and exercise and stay connected to your health care team”

Author(s):

Kawaljit Kaur: Kawaljit is a healthcare professional with an experience of over 15 years in healthcare operations. Her last corporate position was Vice President-Operations at Centre for Sight. As a writer, she has an expertise in writing medical contents and those related to present healthcare scenarios for various platforms that include medical professionals, healthcare companies, web health portals, hospitals and at present also heading the healthcare magazine.

Kawaljit Kaur

Kawaljit is a healthcare professional with an experience of over 15 years in healthcare operations. Her last corporate position was Vice President-Operations at Centre for Sight. As a writer, she has an expertise in writing medical contents and those related to present healthcare scenarios for various platforms that include medical professionals, healthcare companies, web health portals, hospitals and at present also heading the editorial team of a healthcare magazine.

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